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Hyperkalaemia (Symptoms (Aetiology (Redistribution - intracellular to…
Hyperkalaemia
Symptoms
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Fast irregular pulse, chest pain, weakness, light headedness
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May be Kussmaul's respiration - low, deep, sighing inspiration and expiration
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Investigations
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Progressive abnormalities on ECG - tall tented T waves, small P waves and wide QRS complex
Pathophysiology
When K levels in the blood rise - this reduces the difference in electrical potential between cardiac myocytes and outside of the cells, meaning the threshold for action potential is significantly decreased resulting in increased abnormal action potential and thus abnormal heart rhythms that can result in ventricular fibrillation and cardiac arrest
The amount of K in the blood determines the excitability of a nerve and muscle cells, including the heart muscle of myocardium
Treatment Plan
Non-urgent
- Treat underlying cause
- Review medications looking for ACE-i, NSAID and K sparing diuretic
- Dietary K restriction
- Can give polystyrene sultanate resin which binds K in the gut and thus reduces absorption
Urgent - K >7 mmol/L - MEDICAL EMERGENCY
- Stabilise cardiac membrane - IV 10ml 10% Calcium gluconate (reduces the excitability of cardiomyocytes)
- Drive K into cells - soluble insulin (facilitates glucose uptake into cell which brings K with it)
- Must be accompanied by glucose to avoid hypoglycaemia
- Salbutamol - also drive K into cells